Increased intracranial pressure: What to know

Increased intracranial pressure is a medical term that refers to growing pressure inside a person’s skull. This pressure can affect the brain if doctors do not treat it.

A sudden increase in the pressure inside a person’s skull is a medical emergency. Left untreated, an increase in the intracranial pressure (ICP) may lead to brain injury, seizure, coma, stroke, or death.

With prompt treatment, it is possible for people with increased ICP to make a full recovery.

In this article, we look at the symptoms, causes, and treatments of increased ICP.

Symptoms of increased ICP

The symptoms of increased ICP can vary depending on a person’s age.

Infants with increased ICP may have different symptoms to older children or adults with the condition, as discussed below.

Symptoms in adults

Symptoms of increased ICP can include headache, sleepiness, and blurred vision.

Symptoms of increased ICP in adults include:

pupils that do not respond to light in the usual way

headache

behavior changes

reduced alertness

sleepiness

muscle weakness

speech or movement difficulties

vomiting

blurred vision

confusion

As raised ICP progresses, a person may lose consciousness and go into a coma. High ICP may cause brain damage if a person does not receive emergency treatment.

Symptoms in infants

Infants with increased ICP may show some of the same symptoms as adults. In addition, the shape of their heads may be affected.

Infants still have soft plates in their skull that fibrous tissue called skull sutures knit together. Increased ICP may cause the skull sutures to separate and the soft plates to move apart.

Increased ICP in infants may also cause their fontanel to bulge out. The fontanel is the soft spot on the top of the skull.

What is hydrocephalus, or water on the brain?
Hydrocephalus, or fluid on the brain, can cause increased intracranial pressure. Learn more here.
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Causes

The following is a list of medical conditions and other causes that can lead to increased ICP:

brain injury, which is often the result of a blow to the head

hydrocephalus, or too much cerebrospinal fluid on the brain

brain swelling

bleeding or blood pooling in the brain

brain aneurysm

brain infection, such as meningitis or encephalitis

stroke

high blood pressure

brain tumor

drug interaction

seizure

epilepsy

hypoxemia, a blood oxygen deficiency

In infants, high ICP may be the result of child abuse.

If a person handles a baby or infant too roughly, it may cause them to develop a brain injury. This is known as shaken baby syndrome.

One source has estimated that between 1,000 and 3,000 children in the United States experience shaken baby syndrome each year. The condition may arise if an adult shakes a baby violently to stop them crying.

Anyone who suspects a child may be experiencing abuse can contact the National Child Abuse Hotline anonymously at 1-800-4-A-CHILD (1-800-422-4453).

Diagnosis

A doctor may request a CT scan to diagnose increased ICP.

If a person has the symptoms of increased ICP, they should see a doctor straight away. This is a medical emergency and may lead to brain injury if a person does not receive rapid treatment.

A doctor will measure the ICP in millimeters of mercury (mm/Hg). The normal range is less than 20 mm/Hg. When ICP goes above this, a person may be experiencing increased ICP.

To diagnose increased ICP, a doctor may ask if a person has:

experienced a blow to a head

a previous diagnosis of a brain tumor

Then, the doctor may carry out the following tests:

neurological exam to test a person’s senses, balance, and mental state

spinal tap that measures cerebrospinal fluid pressure

CT scan that produces images of the head and brain

After these initial tests, the doctor may use an MRI scan to examine a person’s brain tissue in more detail.

Treatment

If a person has a diagnosis of increased ICP, a doctor will immediately work to reduce the pressure inside the skull to lessen the risk of brain damage. They will then work to treat the underlying cause of the increased pressure.

Treatment methods for reducing ICP include:

draining the excess cerebrospinal fluid with a shunt, to reduce pressure on the brain that hydrocephalus has caused

medication that reduces brain swelling, such as mannitol and hypertonic saline

surgery, less commonly, to remove a small section of the skull and relieve the pressure

A doctor may give the person a sedative to help reduce anxiety and lower their blood pressure. The person may also need breathing support. The doctor will monitor their vital signs throughout their treatment.

In rare cases, the doctor may put a person with high ICP into a medically induced coma to treat their condition.

Complications

Complications of increased ICP include:

brain damage

seizure

stroke

coma

Without proper treatment, increased ICP can be fatal.

Outlook

A sudden increase in ICP is a medical emergency and can be life-threatening. The sooner a person receives treatment, the better their outlook. Many people respond well to treatment, and a person who has experienced increased ICP can make a full recovery.

Preventing increased ICP and its complications

Increased ICP is not always preventable, but it is possible to reduce the risk of some underlying conditions that may lead to increased ICP. We explore how below.

Stroke

A person can reduce ther risk of stroke by exercising regularly.

Stroke may cause increased ICP. A person can reduce their risk of stroke in the following ways:

taking steps to lower high blood pressure

stopping smoking

managing blood sugar levels

controlling cholesterol levels

exercising regularly

High blood pressure

High blood pressure may cause increased ICP. A person can maintain healthy blood pressure by:

losing weight if overweight or maintaining a healthy weight

avoiding drugs that increase blood pressure

eating a healthful, balanced diet

reducing salt intake

exercising regularly

Head injury

A head injury may cause increased ICP. Some examples of how a person can reduce their risk of head injury include:

avoiding extreme sports or dangerous activities

always wearing a helmet for activities such as riding a bike

always wearing a seatbelt when in a car

Summary

Increased ICP is when the pressure inside a person’s skull increases. When this happens suddenly, it is a medical emergency. The most common cause of high ICP is a blow to the head.

The main symptoms are headache, confusion, decreased alertness, and nausea. A person’s pupils may not respond to light in the usual way.

A person with increased ICP may need urgent treatment. The immediate aim of treatment is to bring down the pressure on their brain tissue, which helps to reduce the risk of brain damage.

Without proper treatment, this condition may lead to seizure, coma, stroke, or brain damage. In severe cases, increased ICP can be fatal. Rapid treatment may improve a person’s outlook. Making a full recovery with timely treatment is possible.

Increased ICP is not always preventable, but a person can reduce their risk of some causes through lifestyle changes.

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